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Erythroplakia / Erythroplasia

Erythroplakia (Greek, “flat red area”) is defined as a fiery red patch that cannot be characterised either clinically or
pathologically as any other definable lesion.

These may appear as a bright red, smooth, velvety, granular or nodular lesions often with a well-defined margins
adjacent to normal looking mucosa and are usually asymptomatic.

The soft palate, the floor of mouth, the ventral surface of tongue and the retro-molar area are the most common
sites of involvement.

Erythroplakia is more common among middle aged to elderly persons and, especially among men.  It is less
common than
leukoplakia.

The prevalence of these lesions range from 0.02 - 0.83% in different regions.

Ætiology

The risk factors for erythroplakia are the same as for oral squamous cell carcinoma.

Diagnosis

Erythroplakia is seldom multi-centric and rarely covers extensive areas of the mouth.  It is soft on palpation and
does not become
indurated until an invasive carcinoma develops in it.

It is often asymptomatic, although some patients may complain of a sore, burning or metallic sensation.

Oral erythroplakia has the highest risk of malignant transformation compared to all other mucosal lesions ie
Most potentially malignant of all oral mucosal lesions.

All
erythroplakias should be viewed with extreme clinical suspicion for malignancy, as they are more likely to
harbour
histological foci of severe dysplasia, carcinoma in-situ (CIS) or micro-invasive cancer.

The incidence of
severe dysplasia or carcinoma in these lesions is very high (80 – 90%) and biopsy is mandatory.  
Areas of
erythroplakia may also co-exist with leukoplakia in so-called “mixed” or “speckled” lesions (erythro-
leukoplakia
).

Care must be taken to obtain a representative biopsy specimen in such cases, with sampling of multiple areas
within the lesion, as
carcinoma may be present only focally.
Useful Websites:


Bond's Book of Oral Diseases, 4th Edition

CancerHelp UK

International Agency for Research on Cancer / World Health Organisation


Useful Articles:

Dental Update 1999.  Orofacial Disease.  Update for the Dental Clinical Team.  4. Red, Brown, Black & Blueish
Lesions


British Medical Journal 2000.  ABC of Oral Health.  Oral Cancer

Journal of Dental Education 2002.  Systematic Review of Randomized Trials for the Treatment of Oral Leukoplakia

CA Cancer J Clin 2002.  Oral Cancer and Pre-cancerous Lesions

Critical Reviews in Oral Biology & Medicine 2003.  Prognosis of Oral Pre-malignant Lesions - Significance of
Clinical, Histopathological & Molecular Biological Characteristics

J Can Dent Assoc 2004.  Pigmented Lesions of the Oral Cavity. Review, Differential Diagnosis and Case
Presentations

Oral Oncology 2004.  Oral Erythroplakia - A Review

Red & Mixed Red-White Lesions.  Clinical Stomatology Conference.  September 2007

ENT News 2008 - What is the Risk of a Red or White Lesions in the Mouth Being Malignant?

MJA 2009.  Clinical Update.  Oral White Lesions - Pitfalls of Diagnosis

Head Neck 2009.  Treatment & Follow-up of Oral Dysplasia - A Systematic Review & Meta-Analysis
Laboratory Tests

Histo-pathological examination.


Differential Diagnosis

The following conditions should be considered before making a diagnosis of erythroplakia:



Management / Treatment

Management of oral erythroplakia focuses on the prevention of malignant transformation and early detection of
occult
malignancy.

Persons with
erythroplakia should be advised to stop tobacco / alcohol habits and should be encouraged to take a
diet rich in vegetables and fruits (
anti-oxidants).

In view of the
high malignant potential of these lesions, the recommended treatment is surgical excision, including
laser.  However, even after surgical excision, the recurrences and development of
malignancy at the same site are
high.  In view of this, long-term follow-up is essential even after surgical removal.
Photos of Oral Erythroplakia
Last Updated 16th January 2014
Clinical Features

It appears as a usually asymptomatic, fiery red, well demarcated plaque, with a smooth and velvety surface, usually
level / depressed with surrounding mucosa.  The red lesions may be associated with white spots or small plaques.

The floor of the mouth, retro-molar area, soft palate, and tongue are the most common sites of involvement.

Erythroplakias occurs more frequently between the ages of 50 and 70 years.